- AmeriHealth Caritas (Philadelphia, PA)
- …of medical management authorizations.; + Research and Investigate member and/or provider appeals and grievance requests, including review of UM/claim denial ... system and documents, all correspondence with a member/participant, representative and/or a provider, related to an appeal or...Care environment + 1 to 3 years' experience in grievance / appeals environment required **The Ideal Person will… more
- CVS Health (Harrisburg, PA)
- …-Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system. -Educates ... we do it all with heart, each and every day. **Description** -Customer Service Representative is the face of Aetna and impacts members' service experience by manner… more
- CVS Health (Harrisburg, PA)
- …contract. + Process claim referrals, new claim handoffs, nurse reviews, provider complaints, grievance and appeals via target system. + Assists providers with ... credentialing/re-credentialing and contracting questions and issues. + Assist in compiling claim data for audits. Determines medical necessity, applicable coverage provisions and verifies member plan eligibility relating to incoming correspondence and internal… more